慢性鼻窦炎伴鼻息肉组织中17β-HSD1/17β-HSD2的表达

Expression of 17β-HSD1/17β-HSD2 in Chronic Sinusitis with Nasal Polyps

目的探讨慢性鼻窦炎伴鼻息肉组织中17β-羟基类固醇脱氢酶17β-HSD1和17β-HSD2的表达及意义.方法收集慢性鼻窦炎伴鼻息肉患者86例,根据治疗后内镜鼻息肉评分较治疗前下降水平分为激素敏感组(下降幅度≥1分,50例)、激素不敏感组(下降幅度<1分,36例).激素治疗前取鼻息肉组织,免疫组化法观察17β-HSD1、17β-HSD2的阳性表达情况;RT-PCR和Western blot检测17β-HSD1、17β-HSD2 mRNA和蛋白的表达水平.ROC曲线分析激素治疗前17β-HSD1、17β-HSD2表达水平在评估患者激素敏感性中的应用价值.结果激素敏感组患者合并变应性鼻炎比例、合并哮喘比例明显高于激素不敏感组,差异具有统计学意义(P<0.05);激素敏感组患者治疗后内镜息肉评分明显低于激素不敏感组,嗜酸粒细胞百分比、嗜酸粒细胞绝对值明显高于激素不敏感组,差异具有统计学意义(P<0.05).激素敏感组17β-HSD1 mRNA和蛋白表达水平明显高于激素不敏感组,17βHSD2 mRNA和蛋白表达水平明显低于激素不敏感组,差异具有统计学意义(P<0.05).17β-HSD1/17β-HSD2预测患者激素敏感性的AUC值明显高于单独17β-HSD1、17β-HSD2的AUC值.结论糖皮质激素敏感性患者的鼻息肉组织中17β-HSD1高表达、17β-HSD2低表达;17β-HSD1/17β-HSD2比值与糖皮质激素敏感性明显相关,可作为预测慢性鼻窦炎伴鼻息肉患者糖皮质激素治疗效果的敏感指标.

Objective To investigate the expression and significance of 17 beta-hydroxysteroid dehydrogenase 17β-HSD 1 and 17β-HSD2 in chronic sinusitis with nasal polyps.Method 86 patients with chronic sinusitis and nasal polyps were collected.According to the decrease level of endoscopic nasal polyp score after treatment compared with that before treatment,50 cases were divided into hormone sensitive group(decrease range≥1 point),36 cases were hormone insensitive group(decrease range<1 point).Nasal polyps were harvested before hormone treatment,and the positive expression of 17β-HSD1 and 17β-HSD2 were observed by immunohi-stochemistry.The expression of 17β-HSD1 and 17β-HSD2 were detected by RT-PCR and Western blot.ROC curve analysis of 17β-HSD1 and 17β-HSD2 expression levels before hormone therapy in assessing the value of hormone sensitivity in patients.Results The ratio of allergic rhinitis and asthma in the hormone sensitive group was significantly higher than that in the hormone insensitive group(P<0.05).The endoscopic polyp score in the hormone sensitive group after treatment was significantly lower than that in the hormone insensitive group,and the percentage of eosinophils and the absolute value of eosinophils were significantly higher than that in the hormone insensitive group,with statistically significant differences(P<0.05).The mRNA and protein expression levels of 17β-HSD1 mRNA and protein in the hormone-sensitive group were significantly higher than those in the hormone-insensitive group,and the mRNA and protein expression levels of 17-HSD2 mRNA were significantly lower than those in the hormone-insensitive group,with statistically significant differences(P<0.05).The AUC value predicted by ti-hsd1 and ti-hsd2 was significantly higher than that of ti-hsd1 and ti-hsd2 alone.Conclusion The expression of 17β-HSD1 is high and 17β-HSD2 is low in nasal polyps of patients with glucocorticoid sensitivity.The ratio of 17β-HSD1/17β-HSD2 is significantly correlated with the sensitivity of glucocorticoid,which can be used as a sensitive index to predict the therapeutic effect of glucocorticoid in patients with chronic sinusitis and nasal polyps.